CANTERBURY CHRIST CHURCH UNIVERSITY STUDENT REQUEST FOR LEAVE OF ABSENCE A student wishing to request a leave of absence from their studies at the University should complete this form for each period of absence requested. This form should normally be submitted in advance of any absence and applies only in emergencies or exceptional personal circumstances. For student absence through illness and when students wish to apply for concessions, the ‘Absence through illness of up to 7 days’ or the ‘Student Self-certification and Concessions Request’ forms should be completed, as appropriate. SURNAME: _____________________________ STUDENT ID: ____________________________ Year of study: ________ FORENAME(S): _______________________________________ Programme(s): ______________________________________ (Eg BA Art and Geography, BSc Interprofessional Learning (OT), Dip HE Nursing Studies)
I request a leave of absence
FROM: ____ / ____ / 20____ Day Month Year
TO:
____ / ____ / 20____ Day Month Year
The reason for my request is stated in the box below. (Please note that a leave of absence is normally only agreed in cases of genuine emergency or extenuating circumstances that are unavoidable.) Reason for Request
NB
Formal leave of absence is usually only granted if requests are accompanied by supporting evidence. You should attach all such evidence to this form.
I certify that the information provided above is correct. Signed: __________________________________________ Date: ___________________ The provision of any false information in requesting a period of leave of absence will be treated very seriously and is likely to result in disciplinary action being taken under the University’s procedures. When completed, this form should be sent to the Director of Student Support and Guidance. This can be done via the Campus Tutor (at Broadstairs or Medway), by post to the University’s main Canterbury address, or by handing it in to the Student Support and Guidance Office in Eg18 at the Canterbury Campus. Students at Salomons should address their request to their Programme Director in the first instance. Please ensure that it is submitted at the earliest opportunity so that a prompt decision can be made and communicated to you. For Official use only The request for a Leave of Absence is: Accepted / Declined / Declined pending evidence
Name _____________________________________ Signature _______________________________________ Date ______________________